RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00335
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E4, Bradley Fighting Vehicle System Maintainer, medically separated for “chronic pain right knee, due to patellofemoral chondromalacia without ratable limitation of motion,” with a disability rating of 0%.  

CI CONTENTION:  The applicant contends his service rating should be changed.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20060413	VARD - 20080319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Knee	5099-5003	0%	Right Knee Strain with Instability	5257	10%	20080311	
			Status Post Right Knee Surgery with Scarring	5260	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began January 1999 and was exacerbated in November 2004 after falling from a ladder.  At that time, radiographic studies showed medial meniscal degeneration without a tear.  The CI underwent surgery in March 2005 (arthroplasty and chondroplasty of the patella and trochlear groove; arthroscopic lateral release; and open excision of the tubercle ossicle).  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain patellofemoral chondromalacia Grade II and III (moderate/frequent)” for PEB adjudication.  

At the MEB examination (recorded on DD Form 2807 and 2808) dated 11 February 2006, 3 months prior to separation, the CI reported he had chronic swelling of the knee when standing for long periods of time, pain and locking.  The MEB NARSUM exam, 16 February 2006, noted the absence of swelling and popping.  

At the VA Compensation and Pension (C&P) examination on 11 March 2008, performed 22 months after separation, the CI reported weakness, stiffness, swelling, warmth, giving way, locking and pain (10/10 pain scale).  He was not receiving any treatment for his right knee at the time of the exam.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0% (coded analogously to 5099-5003, degenerative arthritis), citing the absence of ratable limitation of motion.  The VA rated the right knee condition 10%, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability), citing medial and lateral collateral ligaments showed slightly instability.  The VA additionally rated the right knee post-surgery with surgical scars at 10% under code 5260 (leg, limitation of flexion), citing painful motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Although the remote VA exam, 23 months after separation, recorded ratable instability, the preponderance of the exams proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  The Board therefore adjudged that there was insufficient evidence at the time of separation for dual coding the knee (with an instability rating in addition to a painful motion rating).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of cartilage removal (5259) or history of surgery to remove a meniscus (5259) to support any higher rating under the respective codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic pain right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pain Right Knee	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160007254 (PD201400335)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA